Lymphadenectomy in minimally invasive esophagectomy versus open esophagectomy for esophageal cancer; Is there a difference?

Background: The presence of lymph node metastasis is an important prognostic factor for survival in patients with curable esophageal cancer. Lymphatic drainage system of the esophagus is unique due to submucosal lymphatic spread of esophageal tumors so it is unpredictable and highly variable. Minimally invasive esophagectomy (MIE) has lesser complications in resectable esophageal when compared to open esophagectomy (OE). So, we aim to evaluate lymphadenectomy in minimally invasive esophagectomy versus open esophagectomy for esophageal cancer and its impact on short- and long-term outcomes.
Methods: This prospective study was conducted in the surgical oncology department at South Egypt Cancer Institute (SECI) Assiut University (open esophagectomy cases) and Fujita Health University Japan (minimally invasive cases) and included sixty patients diagnosed with esophageal cancer, 20 patients operated by open technique and 40 patients operated by minimally invasive surgery (20 cases thoracoscopic and 20 cases robotic). All patients were divided into two groups (Open and Minimally invasive) then the minimally invasive group was furtherly subdivided into two groups (Thoracoscopic and Robotic). Each group was compared by demographic, clinical, pathological, and surgical factors (Operative time, blood loss, transfusion requirement, and duration of hospital stay), morbidity, mortality, and long term outcomes (Disease-free survival, Over-all free survival) were also assessed.
Results: patients with open esophagectomy had significantly high ICU stay and lower hospital stay in comparison to other groups. Thoracoscopy and robotic groups had insignificant differences regarding hospital stay and ICU stay. Excised lymph nodes were significantly higher among thoracoscopic and robotic groups in comparison to open group while the number of positive lymph nodes had insignificant differences between the three groups. As regards postoperative complications, the open group showed a significant increase in the number of patients with postoperative respiratory complications.
Conclusion: Lymph nodes harvest was significantly higher among thoracoscopic and robotic esophagectomy in comparison to open esophagectomy with significantly lower postoperative respiratory complications and ICU stay. So, MIE is considered a good and safe alternative to open esophagectomy